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Research
zhigang xue
Tongji University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7715-1403
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Background: The progress of coagulation in COVID-19 patients with confirmed discharge status (decease or discharge) and the combination of the autopsy with the complete coagulation parameters were not well studied.
Objective: To clarify the thrombotic phenomena with coagulation progress in COVID-19 patients based on epidemiological statistics combining the autopsy and informatics analysis.
Methods: Using 9 autopsy results with COVID-19 pneumonia and the medical records of 407 patients including 39 deceased ones whose discharge status was certain, time-sequential changes of 11 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Informatics tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severities of COVID-19.
Results: At the beginning of the hospitalization, platelet (PLT) had a significant decrease in critically ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer in critical patients were higher than those in mild and severe during the whole admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score also showed the high DIC level in critical patients. At the relatively late stage of non-survivors, the temporal changes of PLT count, PT, and D-dimer were significantly different from survivors. A random forest model indicated that the most important feature was PT, followed by D-dimer, indicating their positive associations for the severities of disease. Autopsy data from 9 deceased patients also showed the DIC phenomena with prolonged PT, APTT, less PLT count and thrombosis in multiple organs.
Conclusions: Combining autopsy data, time-sequential changes and informatics methods to explore the coagulation relevant indices among the different severities of the disease, helps guide the therapy and detect the prognosis in COVID-19 infection.
Keywords
COVID-19, thrombosis, coagulation, autopsy, informatics
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at Thrombosis Journal.
No community comments so far
Editorial decision: Accept
On 22 Dec, 2020
Editor assigned
On 21 Dec, 2020
Submission checks complete
On 21 Dec, 2020
Editor invited
On 21 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 07 Dec, 2020
Review #2 received
Received 03 Dec, 2020
Review #1 received
Received 03 Dec, 2020
Reviewer #2 agreed
On 25 Nov, 2020
Reviewer #1 agreed
On 25 Nov, 2020
Reviewers invited
Invitations sent on 16 Nov, 2020
Editor assigned
On 15 Nov, 2020
Submission checks complete
On 15 Nov, 2020
Editor invited
On 15 Nov, 2020
Version 2
Posted 28 Oct, 2020
No comments provided
Review #1 received
Received 28 Oct, 2020
Editorial decision: Major revision
On 28 Oct, 2020
Reviewer #2 agreed
On 23 Oct, 2020
Review #2 received
Received 23 Oct, 2020
Reviewer #1 agreed
On 22 Oct, 2020
Reviewers invited
Invitations sent on 20 Oct, 2020
Editor assigned
On 19 Oct, 2020
Submission checks complete
On 18 Oct, 2020
Editor invited
On 18 Oct, 2020
No comments provided
Editorial decision: Major revision
On 04 Sep, 2020
Review #2 received
Received 02 Sep, 2020
Review #1 received
Received 17 Aug, 2020
Reviewer #2 agreed
On 03 Aug, 2020
Reviewers invited
Invitations sent on 02 Aug, 2020
Reviewer #1 agreed
On 02 Aug, 2020
First submitted
On 19 Jul, 2020
Editor assigned
On 19 Jul, 2020
Submission checks complete
On 18 Jul, 2020
Editor invited
On 18 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Hematology
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A new preprint design is coming!
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See the published version of this preprint at Thrombosis Journal.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
zhigang xue
Tongji University School of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7715-1403
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Thrombosis Journal.
No community comments so far
Editorial decision: Accept
On 22 Dec, 2020
Editor assigned
On 21 Dec, 2020
Submission checks complete
On 21 Dec, 2020
Editor invited
On 21 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 07 Dec, 2020
Review #2 received
Received 03 Dec, 2020
Review #1 received
Received 03 Dec, 2020
Reviewer #2 agreed
On 25 Nov, 2020
Reviewer #1 agreed
On 25 Nov, 2020
Reviewers invited
Invitations sent on 16 Nov, 2020
Editor assigned
On 15 Nov, 2020
Submission checks complete
On 15 Nov, 2020
Editor invited
On 15 Nov, 2020
Version 2
Posted 28 Oct, 2020
No comments provided
Review #1 received
Received 28 Oct, 2020
Editorial decision: Major revision
On 28 Oct, 2020
Reviewer #2 agreed
On 23 Oct, 2020
Review #2 received
Received 23 Oct, 2020
Reviewer #1 agreed
On 22 Oct, 2020
Reviewers invited
Invitations sent on 20 Oct, 2020
Editor assigned
On 19 Oct, 2020
Submission checks complete
On 18 Oct, 2020
Editor invited
On 18 Oct, 2020
No comments provided
Editorial decision: Major revision
On 04 Sep, 2020
Review #2 received
Received 02 Sep, 2020
Review #1 received
Received 17 Aug, 2020
Reviewer #2 agreed
On 03 Aug, 2020
Reviewers invited
Invitations sent on 02 Aug, 2020
Reviewer #1 agreed
On 02 Aug, 2020
First submitted
On 19 Jul, 2020
Editor assigned
On 19 Jul, 2020
Submission checks complete
On 18 Jul, 2020
Editor invited
On 18 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Hematology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Thrombosis Journal.
Background: The progress of coagulation in COVID-19 patients with confirmed discharge status (decease or discharge) and the combination of the autopsy with the complete coagulation parameters were not well studied.
Objective: To clarify the thrombotic phenomena with coagulation progress in COVID-19 patients based on epidemiological statistics combining the autopsy and informatics analysis.
Methods: Using 9 autopsy results with COVID-19 pneumonia and the medical records of 407 patients including 39 deceased ones whose discharge status was certain, time-sequential changes of 11 relevant indices within mild, severe and critical infection throughout hospitalization according to the Chinese National Health Commission (NHC) guidelines were evaluated. Informatics tools were applied to calculate the importance of 11 indices and the correlation between those indices and the severities of COVID-19.
Results: At the beginning of the hospitalization, platelet (PLT) had a significant decrease in critically ill patients. Blood glucose (GLU), prothrombin time (PT), activated partial thromboplastin time (APTT), and D-dimer in critical patients were higher than those in mild and severe during the whole admission period. The International Society on Thrombosis and Haemostasis (ISTH) disseminated intravascular coagulation (DIC) score also showed the high DIC level in critical patients. At the relatively late stage of non-survivors, the temporal changes of PLT count, PT, and D-dimer were significantly different from survivors. A random forest model indicated that the most important feature was PT, followed by D-dimer, indicating their positive associations for the severities of disease. Autopsy data from 9 deceased patients also showed the DIC phenomena with prolonged PT, APTT, less PLT count and thrombosis in multiple organs.
Conclusions: Combining autopsy data, time-sequential changes and informatics methods to explore the coagulation relevant indices among the different severities of the disease, helps guide the therapy and detect the prognosis in COVID-19 infection.
Figure 1
Figure 2
Figure 3
Figure 4
This is a list of supplementary files associated with this preprint. Click to download.
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